Wide local excision surgery is local therapy for Stage 0 to Stage 2 Melanomas, which includes severely atypical lesions, Melanoma in-situ and Invasive Melanomas 0-2mm in thickness.

A wide local excision is a procedure in which an area of skin and tissue surrounding the Melanoma is removed. The skin and tissue removed (called the “excision”) will extend through the fat, down to your muscle, but no muscle will be removed.

The amount of tissue removed around the Melanoma depends on the Breslow depth (thickness) of the Melanoma, which is found on the original biopsy pathology report. Dr. Guillemaud will review your pathology report with you and will recommend that 0.5-2cm (approximately ½-1 inch) of skin and tissue be removed surrounding the Melanoma, depending on your Melanoma’s thickness

This additional skin and tissue is removed to help prevent a recurrence of the Melanoma. There is a 30-60% chance that the Melanoma will recur at the primary site if this additional skin and tissue is not removed.

During surgery, Dr. Guillemaud will mark a 0.5 to 2 cm circle around the original Melanoma (depending on your Melanoma’s thickness). This may be around any remaining Melanoma after your biopsy using a special light, or around the scar left from your Melanoma. Dr. Guillemaud will reshape this circle to an ellipse shape (the shape of a football). This shape improves the closure of the excision so the tissue lies in a nice, straight line.

The excision will be closed with sutures. Because the wide excision removes a large piece of tissue and skin (several centimeters in length), the excision is often very tight and will have a prolonged healing period. This means you will have significant activity restrictions for several days to weeks after your surgery. The stitches will need to remain in place for 14-21 days. On rare occasions when there is no tension on the incision, absorbable sutures may be used.

Indentation after Melanoma wide excision

Because all the underlying fat is removed underneath the Melanoma during the excision, when the tissue is brought back together, an indent remains underneath the excision. This is done on purpose for Melanomas to allow for assessment of the underlying blood vessels and nerves. This is not typical with other surgeries but is done intentionally with Melanomas. For some people, the indentation will reduce with time, but most are left with some type of indent under the excision.

Reconstruction

There may be times that the excision is so big that the surrounding tissues aren’t able to stretch over the site to close it. If this is the case, the surgical area may be closed using a rotational or advancement flap. This involves loosening the surrounding tissues from their underlying structures and then moving them to cover the defect. If this cannot be done, sometimes a skin graft will need to be done. This involves borrowing skin from somewhere else on the body and transplanting the skin onto the area where the Melanoma was removed.

Calgary Skin Cancer Centre

Indentation after Melanoma wide excision

Reconstruction

Before and After Melanoma Wide Excisions